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Dollar driven choices cannot trump ethics

ETHICS MADE REAL

GORDON SELF

January 31, 2011

This month's column will coincide with the arrival of credit card statements in the mail. After the spending spree of Christmas the reality of what we now owe follows. For some, January bills can serve as a wake up call as to their total debt load, which may require immediate corrective action.

It is sad that consumerism which has grossly distorted the liturgical beauty and simplicity of this season brings such a financial hangover. The spiraling effects of debt in terms of family stress, insecurity, despair, even domestic abuse or risk of suicide also needs to be tallied as total societal costs.

As much as reconciling our chequebook is a financial exercise, it is also a moral one. Most people have to make choices where they put their money, based on their limited resources, and therefore will tend to allocate on what they deem most important, or valuable.

These value choices may be especially difficult if trying to satisfy two equally important needs. Yes, while some of our credit card bills are due to overindulging our Yuletide appetites, sometimes even frivolously; for others, it may have been the choice of ensuring a modest gift under the tree for all their young children, and, still having enough to pay the rent.

In health care, we are confronted everyday with resource allocation decisions, requiring choices among competing values. As I write this article flu season is beginning to hit, adding additional pressure to an overstretched health care system.

We cannot ignore this surge, especially knowing the frail elderly and young children are especially vulnerable to influenza. At the same time, those waiting for elective procedures, cancer surgeries and other urgent or emergent health needs also cannot be ignored. It is not such a simple matter as choosing some patient groups and disregarding others.

Like the example above, a financially strapped family cannot simply buy one gift for all their kids and ignore the rent. Or just buy for one child, and not the other children.

Similarly, in health care we need to ensure there are adequate resources in the system so all those requiring our support are appropriately cared for, in the right setting, in the right bed and at the right time. Resource allocation requires incredible tenacity and creativity.

WHICH ONE?

Our moral imagination is especially tested when having to choose between two equally valuable and weighted needs, but only one can be satisfied. We may have all the resources in the world - money, time, people and so forth, except, unfortunately, the ability to do both.

Sometimes these choices involve lives. For example, this time of year often brings news of avalanche tragedy. All the personnel, helicopters and tracking devices cannot justify risking more lives lost if darkness or deteriorating weather conditions prevent search and rescue operations to continue.

These are ethically justifiable decisions, but it does not mean they are easy, and our support and compassion must go out to those heroic individuals despite the helplessness we all feel given the limits of whom we can save.

Equally challenging issues can present themselves in health care, too. Responding promptly and compassionately to a gravely ill woman will require prudent ethical reflection first if treatments she requires to save her life may threaten the unborn child she is carrying.

KEEP THE FAITH

In this case, how do we remain faithful to magisterial Catholic teaching that upholds the intrinsic dignity and equal worth of both mother and child, and still act without abandoning good principles, the mother, the unborn child, the medical team and sometimes, the ethicist on the front line in the process?

Doing good ethics requires discipline. While working in Iowa I used to swim everyday and got to know the regulars at the local YMCA. Shortly after New Year's I noticed how the locker room suddenly was so crowded. One of the regulars told me not to worry, that it was just the "Resoluters" who made half promises over the holidays that invariably would not last, and they would soon leave.

This is a good lesson for those awakened by their credit card bills to put into practice disciplined budgetary practices lest they are again faced with the same dilemma next year.

Likewise, in health care and the other arenas of our life, it is important we take a consistent ethical approach in all the decisions we make and to continually reflect on what we are doing, and why. Extremely emotion-laden cases that attract media attention and polarize public debate should not cause us to react and abandon well-developed Catholic ethical traditions and principles.

It is here especially that we need an impassionate judgment. We cannot afford as a Catholic community to scrimp on compassion.

We are called to be more than just Ethical Resoluters who lack the stick-to-it-ness to think through the many subtleties of an issue, or having the resolve to do something, even if it may be incomplete, as Archbishop Oscar Romero wrote. We must be compassionate to stand with those who make ethically justified, but nonetheless difficult decisions.

(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached atmes@covenanthealth.ca.)